Background The effects of COVID-19 on harmful traditional practices such Female Genital Mutilation/Cutting (FGM/C) and Child or Forced Marriages (CFM) have not been well documented. We examined respondents’ perceptions on how the COVID-19 pandemic has affected FGM/C and CFM in Kenya, Uganda, Senegal, and Ethiopia. Methods A cross-sectional study design with a mixed methods approach was used. Data collection on participants’ perceptions on the effects of COVID-19 on FGM/C and CFM took place between October-December 2020. Household surveys targeting women and men aged 15–49 years in Kenya (n = 312), Uganda (n = 278), Ethiopia (n = 251), and Senegal (n = 208) were conducted. Thirty-eight key informant interviews with programme implementers and policymakers were carried out in Kenya (n = 17), Uganda (n = 9), Ethiopia (n = 8), and Senegal (n = 4). Results In Kenya, the COVID-19 pandemic has contributed to the increase in both FGM/C and CFM cases. Minimal increase of FGM/C cases was reported in Uganda and a significant increase in CFM cases. In Ethiopia, the COVID-19 pandemic had a limited perceived effect on changes in FGM/C and CFM. In Senegal, there were minimal perceived effects of COVID-19 on the number of FGM/C and CFM cases. The pandemic negatively affected implementation of interventions by the justice and legal system, the health system, and civil societies. Conclusions The pandemic has had varied perceived effects on FGM/C and CFM across the four countries. Generally, the pandemic has negatively affected implementation of interventions by the various sectors that are responsible for preventing and responding to FGM/C and CFM. This calls for innovative approaches in intervening in the various communities to ensure that women and girls at risk of FGM/C and CFM or in need of services are reached during the pandemic. Evidence on how effective alternative approaches such as the use of call centres, radio talk shows and the use of local champions as part of risk communication in preventing and responding to FGM/C and CFM amid COVID-19 is urgently required.

Background: Coronavirus disease (COVID-19) caused socio-economic disruptions across the globe. The pandemic disrupted the health system (HS) calling for reengineering in response to high infection rates, deaths, and resultant containment measures. To deal with COVID-19 and promote resilience, community health workers (CHWs) were engaged across countries. Objective: Assess the preparedness of CHWs in supporting health system response in prevention and management of COVID-19 in Kenya, Senegal, and Uganda. Methods: A mixed methods design study involving national and subnational jurisdictions in the 3 countries. Key informant interviews were conducted with policy actors (16) and health care workers (24) while in-depth interviews involved CHWs (14) and community members (312) subjected to survey interviews. Results: Most (>50%) households survived on <USD 100/month during COVID-19 announced in March 2020 through national TV (57%), FM (42%), and radio station (27%). Community members interactions with CHWs increased during the pandemic through home visits as health educators, basic counseling providers and distributors of pandemic information tools, personal protective equipments, and social support commodities. The CHWs faced challenges during pandemic prevention and management including lack of: protective gear, salary, refresher courses, and identification tools; limited supervision and training; hostile reception during home visits; misconception and politicking about the pandemic. To effectively support prevention and manage of COVID-19, priority needs for CHWs were identified namely: provision of resources, protective gear, transport reimbursement, stipends, identification cards, and tools for recording and reporting; empowerment with adequate skills, trainings on provision of psychosocial support, first aid, and sensitization on policies. Conclusion: COVID-19 linked disruptions to optimal functioning of HS necessitated engagement of CHWs in the pandemic prevention and management. Findings underscore the important role CHWs play in supporting HS during crisis like COVID-19 to mitigate disruptions and stabilize the system for effective response. The CHWs can improve resilience of social and HS during unplanned disruptions for optimal functioning and attainment of universal health care. Policy makers should develop structured mechanisms for engaging CHWs while committing resources to address challenges that affect seamless synergy between health and CHWs Systems.

No abstract

Background The effects of COVID-19 on harmful traditional practices such Female Genital Mutilation/Cutting (FGM/C) and Child, Early or Forced Marriages (CEFM) have not been well documented. We examined how the COVID-19 pandemic has affected FGM/C and CEFM in Kenya, Uganda, Senegal, and Ethiopia. Methods A cross-sectional study design with a mixed methods approach was used. Household surveys targeting women and men aged 15–49 years in Kenya (n = 312), Uganda (n = 278), Ethiopia (n = 251), and Senegal (n = 208) were conducted. Thirty-eight in-depth interviews with programme implementers and policymakers were carried out in Kenya (n = 17), Uganda (n = 9), Ethiopia (n = 8), and Senegal (n = 4). Results In Kenya, the COVID-19 pandemic has contributed to the increase in both FGM/C and CEFM cases. Minimal increase of FGM/C cases was reported in Uganda and a significant increase in CEFM cases. In Ethiopia, the COVID-19 pandemic had a limited effect on changes in FGM/C and CEFM. In Senegal, there were minimal effects of COVID-19 on the number of FGM/C and CEFM cases. The pandemic has negatively affected implementation of interventions by the justice and legal system, the health system, and civil societies. Conclusions The pandemic has had varied effects on FGM/C and CEFM across the four countries. Across the four countries, the pandemic has negatively affected implementation of interventions by the various sectors that are responsible for preventing and responding to FGM/C and CEFM. This calls for innovative approaches in intervening in the various communities to ensure that women and girls at risk of FGM/C and CEFM or in need of services are reached during the pandemic. Evidence on how effective alternative approaches such as the use of call centres, radio talk shows and the use of local champions as part of risk communication in preventing and responding to FGM/C and CEFM amid COVID-19 is urgently required.

Background Evidence on the impact of Maternal Newborn and child health (MNCH) and Water, Sanitation and Hygiene (WASH) interventions on skilled birth attendance and neonatal sepsis remains unclear. We assessed the effect of WASH/MNCH integrated interventions on skilled birth attendance and incidence of neonatal Sepsis in a resource-constrained setting in Uganda. Methods A quasi-experimental study design was conducted in Amuru district. The package of interventions implemented included; training of health workers, facilitation of integrated outreach services, construction of WASH facilities, and health education of communities. A digitized structured questionnaire was used to obtain data on ANC and skilled birth attendance, WASH practices and prevalence of pneumonia and diarrhea among 466 expectant mothers and caretakers of under-fives at baseline, midterm and endline. Data on the incidence of sepsis, ANC and skilled birth attendance, and WASH status was also obtained from 6 healthcare facilities. A total of 12 key informant interviews and 12 Focus group discussions were also conducted. Data were imported into STATA 15 for analysis. Two sample tests of proportions were used to compare findings at baseline and endline. Qualitative was analyzed using thematic content analysis. Results There was a significant increase in the number of women delivering at the health facilities that were supported by the project from 41.4% at baseline to 63.0% at endline (p= <0.0001). There was a reduction in the incidence of neonatal sepsis from 0.6% to 0.2% (p = 0.0687), although the difference was not significant. There was an increase in the percentage of households with sanitation facilities and improved hygiene practices. Community-level findings also indicated a decline in cases of water-borne illnesses; cases of dysentery decreased from 10.0% at baseline to 0.6% at endline, cases of cholera decreased from 8.9% to 1.9% at endline, cases of typhoid decreased from 26.5% to 12.7% at endline. Conclusion This study revealed that integrated WASH/MNCH interventions can significantly increase ANC and skilled birth attendance, reduce incidences of neonatal sepsis, diarrhea, pneumonia, and other related diseases and improve WASH practices in communities. Significant improvements in WASH/IPC in the maternity wards and the capacity of healthcare workers to deliver clean and safe MNCH services can also be realized. We recommend the integration of WASH/MNCH interventions for projects aimed at improving skilled birth attendance and WASH practices and reduction of childhood infections.